Children's liver chemistries vary with age and gender and require customized pediatric reference ranges

Used to detect liver disease and injury, baseline liver chemistry distributions were evaluated by age and gender in children without known liver disease. Baseline liver chemistries [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TBI...

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Published in:Regulatory toxicology and pharmacology 2015-10, Vol.73 (1), p.349-355
Main Authors: Stirnadel-Farrant, Heide A., Galwey, Nicholas, Bains, Chanchal, Yancey, Caroline, Hunt, Christine M.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Alanine aminotransferase
Alanine Transaminase - metabolism
Alkaline phosphatase
Alkaline Phosphatase - metabolism
Aspartate Aminotransferases - metabolism
Bilirubin - metabolism
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Laboratory reference ranges
Liver - metabolism
Liver - physiology
Liver chemistries
Liver Diseases - metabolism
Liver Diseases - physiopathology
Liver Function Tests - methods
Male
Pediatric clinical trials
Reference Values
Young Adult
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Summary:Used to detect liver disease and injury, baseline liver chemistry distributions were evaluated by age and gender in children without known liver disease. Baseline liver chemistries [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TBIL)] were analyzed from 24 randomized controlled pediatric clinical trials. Using quantile regression, liver chemistry distributions were examined by age and gender; upper limit normal (ULN) ranges were compared to the 97.5th percentiles of the distributions for the specified ages and genders. 5410 subjects without known liver disease (0–18 years; 60% male) were studied. The median ALT varied little with age. In males age 5–18, the ALT 97.5th percentile increased from 34 to 63 IU/L. In both genders, the median and 97.5th percentile AST decreased with age. After age 9, ALP decreased. TBIL increased with age. Despite most liver chemistry 97.5th percentiles changing substantively with age and gender, the reference lab ULN generally changed minimally and did not correlate with the 97.5th percentile. Gender and age specific 97.5th percentile data should therefore be considered for the reference laboratory ULN in children to more accurately detect liver injury and disease. •Data on normal liver chemistry distributions is limited in children.•In particular, the 97.5th percentiles differed from standard reference ranges.•ALT 97.5th percentile was high in males aged ≥5.•AST and ALP decreased and TBIL increased with children's age in both genders.•Gender and age specific reference ranges should be used to detect liver disease.
ISSN:0273-2300
1096-0295
DOI:10.1016/j.yrtph.2015.07.013